<%@ page language="java" contentType="text/html; charset=UTF-8"
    pageEncoding="UTF-8"%>
<!DOCTYPE html>
<html><head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
<title>商家申请</title>
<link rel="stylesheet" href="register_files/apply.233653ce.css">
<link href="../index/details_files/vendor.606e96.css" rel="stylesheet">
<link href="../index/details_files/main.153014.css" rel="stylesheet">
<%@ include file="../elements/head.jsp" %>
</head>
<body>

  <header class="header--pc h5-hidden">
  	<%@ include file="../elements/top.jsp" %>
  	<script type="text/javascript">
  		$("#login_entry").hide();
  	</script>
  </header>
  
  <div class="wrapper" style="margin-top: 50px;">
    <div class="apply">
      <div class="apply__form">
        <h1>商家信息申请表</h1>
        <div class="apply__form-body">
          <label>用户名 <span>*</span></label>
          <input id="name" type="text" autocomplete="off">
          <p id="nameError" class="error"></p>

          <label>身份证号 <span>*</span></label>
          	<input id="idCard" type="text" autocomplete="off">
          <p id="idCardError" class="error"></p>

       
          <label>手机号 <span>*</span></label>
          	<input id="phone" type="tel" autocomplete="off">
          <p id="phoneError" class="error"></p>

		  <label>起送费 <span>*</span></label>
          	<input id="" type="tel" autocomplete="off">
          <p id="phoneError" class="error"></p>

		  <label>是否营业 <span>*</span></label>
          	<input id="" type="tel" autocomplete="off">
          <p id="phoneError" class="error"></p>
          
          <label>商家类型<span>*</span></label>
          	<input id="" type="tel" autocomplete="off">
          <p id="phoneError" class="error"></p>
          
          <label>商家公告 <span>*</span></label>
          	<input id="" type="tel" autocomplete="off">
          <p id="phoneError" class="error"></p>
          
          <label>营业执照编号<span>*</span></label>
          	<input id="" type="tel" autocomplete="off">
          <p id="phoneError" class="error"></p>

          <label>地址 <span>*</span></label>
          <select id="workProvince" name="province">
            <option value="_empty">请选择省份</option>
          	<option value="10012">安徽省</option>
          	<option value="10033">澳门特别行政区</option>
          	<option value="10001">北京市</option>
          	<option value="10022">重庆市</option>
          	<option value="10013">福建省</option>
          	<option value="10028">甘肃省</option>
          	<option value="10019">广东省</option>
          	<option value="10020">广西壮族自治区</option>
          	<option value="10024">贵州省</option>
          	<option value="10021">海南省</option>
          	<option value="10003">河北省</option>
          	<option value="10008">黑龙江省</option>
          	<option value="10016">河南省</option>
          	<option value="10017">湖北省</option>
          	<option value="10018">湖南省</option>
          	<option value="10010">江苏省</option>
          	<option value="10014">江西省</option>
          	<option value="10007">吉林省</option>
          	<option value="10006">辽宁省</option>
          	<option value="10005">内蒙古</option>
          	<option value="10030">宁夏回族自治区</option>
          	<option value="10029">青海省</option>
          	<option value="10015">山东省</option>
          	<option value="10009">上海市</option>
          	<option value="10004">山西省</option>
          	<option value="10027">陕西省</option>
          	<option value="10023">四川省</option>
          	<option value="10034">台湾省</option>
          	<option value="10002">天津市</option>
          	<option value="10032">香港特别行政区</option>
          	<option value="10031">新疆维吾尔自治区</option>
          	<option value="10026">西藏自治区</option>
          	<option value="10025">云南省</option>
          	<option value="10011">浙江省</option>
          </select>
          <span class="select-arrow"></span>
          <select id="workCity">
            <option value="_empty">请选择城市</option>
          </select>
          <span class="select-arrow"></span>
          <select id="workDistrict">
            <option value="_empty">请选择区/县 (非必填)</option>
          </select>
          <span class="select-arrow"></span>
          <p class="error"></p>
          
		  <label>详细地址<span>*</span></label>
          	<input id="" type="tel" autocomplete="off">
          <p id="phoneError" class="error"></p>
          
          
          <label>商家图片<span>*</span></label>
          	<input type="file" autocomplete="off">
          <p id="staffError" class="error"></p>

          <div class="apply__btn-box">
            	<input type="submit" class="apply__btn primary" value="确认提交" />
          </div>
        </div>
      </div>
    </div>
  </div>
</body>
</html>